title: Health care professionals' pain narratives in hospitalized children's medical records. Part 2: structure and content.
abstract: BACKGROUND
  Although clinical narratives - described as free-text notations--have been noted to be a source of patient information, no studies have examined the composition of pain narratives in hospitalized children's medical records.
  
  
  OBJECTIVE
  To describe the structure and content of health care professionals' narratives related to hospitalized children's acute pain.
  
  
  METHODS
  All pain narratives documented during a 24 h period were collected from the medical records of 3822 children (0 to 18 years of age) hospitalized in 32 inpatient units in eight Canadian pediatric hospitals. A qualitative descriptive exploration using a content analysis approach was performed.
  
  
  RESULTS
  Three major structural elements with their respective categories and subcategories were identified: information sources, including clinician, patient, parent, dual and unknown; compositional archetypes, including baseline pain status, intermittent pain updates, single events, pain summation and pain management plan; and content, including pain declaration, pain assessment, pain intervention and multidimensional elements of care.
  
  
  CONCLUSIONS
  The present qualitative analysis revealed the multidimensionality of structure and content that was used to document hospitalized children's acute pain. The findings have the potential to inform debate on whether the multidimensionality of pain narratives' composition is a desirable feature of documentation and how narratives can be refined and improved. There is potential for further investigation into how health care professionals' pain narratives could have a role in generating guidelines for best pain documentation practice beyond numerical representations of pain intensity.
authors.forename: Judy
authors.initials: J
authors.lastname: Rashotte
authors.forename: Denise
authors.initials: D
authors.lastname: Harrison
authors.forename: Geraldine
authors.initials: G
authors.lastname: Coburn
authors.forename: Janet
authors.initials: J
authors.lastname: Yamada
authors.forename: Bonnie J
authors.initials: BJ
authors.lastname: Stevens
mesh_terms: D000293:Adolescent; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data; D002675:Child, Preschool; D004282:Documentation / Q000592:standards; D005260:Female; D006282:Health Personnel / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007802:Language; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D010146:Pain; D010372:Pediatrics / Q000592:standards